Chest pain surgery

Chest pain Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Chest pain from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Chest Pain in Pregnancy
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Chest pain surgery On the Web
Most recent articles
cited articles
Review articles
CME Programs
Powerpoint slides
Images
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Chest pain surgery
CDC on Chest pain surgery
Chest pain surgery in the news
Blogs on Chest pain surgery
to Hospitals Treating Chest pain surgery
Risk calculators and risk factors for Chest pain surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]

Overview

Surgery may be indicated in the setting of an MI (angioplasty) or in an aortic dissection.

Surgery

Common causes of acute chest pain in the months after CABG include:

• Musculoskeletal pain from sternotomy: the most common cause
• Myocardial ischemia from acute graft stenosis or occlusion
• Pericarditis
• Pulmonary embolism
• Sternal wound infection
• Nonunion
• Post-sternotomy pain syndrome is defined as discomfort after thoracic surgery, persisting for at least 2 months, and without apparent cause.
• The incidence of post-sternotomy pain syndrome is varied 7%-66% with a higher prevalence in women compared with men within the first 3 months of thoracic surgery but, after 3 months, postoperative sex difference in prevalence was not seen.
• Causesa of Graft failure within the first year post-CABG using saphenous venous grafts are:
• Technical issues
• Intimal hyperplasia
• Thrombosis
• Internal mammary artery graft failure within the first-year post-CABG is most commonly attributable to issues with the anastomotic site of the graft.
• Causes of acute chest pain several years after CABG including:

  Graft stenosis

  Occlusion or progression of disease in a non-bypassed vessel

• One year after CABG, about 10%-20% of saphenous vein grafts fail.
• By 10 years, about half of saphenous vein grafts are patent.
• The internal mammary artery has patency rates of 90% to 95% 10 to 15 years after CABG.
• The use of radial artery grafts for CABG has a higher patency rate at 5 years of follow-up, compared with the use of saphenous vein grafts.

• For patients with aortic dissections, emergent surgery may be required.
• Although often fatal, aortic dissection is an indication for urgent surgical therapy.